Donald WagnerLCITYCLER r, eaeived
CALIF ORNIA 11
STATEMENT OF ECONOMIC INTE N1 e E l"s" i"
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE 5
Please type or print in ink A Public Document FFICEI
NAME (LAST) (FIRST) ( MIDDLE) DAYTIME TELEPHONE NUMBER
r2 s )56f -
JG ADDRESS STREET
use business address)
1 . Office, Agency, or Court
Name of Office, Agency, or CCo " or
Divisio , Board, District, if applicable:
You Position:
A -
If filing for multiple postions, list additional agency(ies)/
position(s): (Attach aseparate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ County ofy prA
`City Of
V' F - 1 Multi- County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date:��—
Annual: The period covered is January 1, 2004,
through December 31, 2004.
-or-
0 The period covered is through
December 31, 2004.
❑ Leaving Office Date Left: —J —
(Check one)
0 The period covered is January 1, 2004, through the
date of leaving office.
-or-
0 The period covered is through
the date of leaving office.
❑ Candidate
STATE ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS
4. Schedule Summary
(Check applicable schedules or "No reportable interests.')
During the reporting period, did you'have any reportable
interests to disclose on:
Schedule A-1 [] Yes - schedule attached
Investments (Less than 10% Ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments (10% ar greater Ownership)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income, Loans, 6 Business Positions (Income Other than Gins and
Trevet Payments)
Schedule D (Eliminated - report loans on Schedule C)
Schedule E Yes - schedule attached
Income -Gifts
Schedule F ❑ Yes - schedule attached
Income - Travel Payments
-or-
No reportable interests on any schedule
Total number of pages
completed including this cover page:
5. Verification
I have used all reasonable diligence in preparing this statement.
I have reviewed this statement and to the best of my knowledge
the information contained herein and in any attached schedules
is true and complete.
1 certify under penalty of perjury under the laws of the State
of California that the foreg . ng is true and correct.
Date Signed
( nlf day, year)
Signature ...
file [he finally signetl stalemenl with your filing official.)
FPPC Form 700 (200412005)
FPPC Toll -Free Helpline: 866 /ASK -FPPC
SCHEDULE E
Income - Gifts
> NAME OF SOURCE
IrJ,LLW A5%(- 4ps
ADDRESS
&i6mA flWV Imidimt'YN
BUSINESS ACTIVITY, IF ANY,'OF SOURCE
DAm /yy) V UE , D DE E SS� C , R , IIP � TIO OF GIFT(S)
AT
�Ac $
--J --J— $ >.NAME OF SOURCE
W l LW, OeK R emo
ADDRESS
a tM ZA sw& 13S ^gk-L
BUSINESS ACT VITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALLUUEE ' DESCRIPTION OF GIFT(S)
P� _s /'mil`
$
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy)
VALUE
$
$
—J —J
$
DESCRIPTION OF GIFT(S)
Comments:
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE -
DATE (mm /dd /yy) VALUE
—J � $
—J � $
DESCRIPTION OF GIFT(S)
> NAME OF SUURGE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE
$
$
DESCRIPTION OF GIFT(S)
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm )dd /yy)
VALUE
$
$
$
DESCRIPTION OF GIFT(S)
FPPC Form 700 (200412005) Sch. E
FPPC Toll -Free Helpline: 866 1ASK -FPPC